I read with great interest the article “Autonomic activation in insomnia: the case for acupuncture” by Wei Huang et al.1 published in the Journal of Clinical Sleep Medicine in February 2011. The article suggested that acupuncture can have a role in treating comorbid insomnia through autonomic activation.
However, most of the studies in the literature with acupuncture as a therapy for various medical conditions are mostly very controversial. The authors of the article “Acupuncture for insomnia” in the Cochrane Database System Review in 20072 concluded that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Some of the well-designed studies suggested that acupuncture has a beneficial role and is efficacious in treating chronic pain related conditions like chronic low back pain as seen in the GERAC study.3
All the patients reported in Wei Huang et al.1 had chronic insomnia along with chronic pain syndrome. As per the ICSD-2 classification, all these patients suffer from comorbid insomnia secondary to medical condition.4 So it may be argued that the efficacy of acupuncture for insomnia as seen in the patients quoted in the paper was a result of selection bias, as their pain was treated through the acupuncture and hence their comorbid insomnia symptoms improved.
I agree with the authors that acupuncture may have a therapeutic benefit in a subset of chronic insomniacs, mostly comorbid insomnia secondary to medical condition like chronic pain syndrome. On the same token, acupuncture most likely would not be beneficial in all forms of chronic insomnia as has been alluded in this paper.
CBT I (Cognitive Behavioral Therapy- Insomnia) have been recommended in the guidelines for treatment for chronic insomnia.5 The guidelines also suggest the long term efficacy of CBT treatment over medications for the treatment for chronic insomnia. In the future, a large well-designed randomized control study between CBT and acupuncture for chronic insomnia will help us to evaluate the efficacy of acupuncture in treatment of chronic insomnia.
This was not an industry supported study. The author has indicated no financial conflicts of interest.